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<br />MUKILTEO WATER DISTRICT
<br />SNOHOMISH COUNTY WASHINGTON
<br />�
<br />APPLICATION FOR WATER
<br />Applicatio� No. �
<br />I✓�eier Size l�� Nu �b� r of Units �_
<br />,�/n
<br />VI
<br />J ��
<br />No. ���/�I� ;,—
<br />Account No. � v��'/�!�7���
<br />I hereby apply for water service and agree to be governed in accordance wilh ihe resolutions, rules and regulations o( the
<br />MUK,ILTcO VJATER DISTP�CT pertaining to watar service, now or hereaifer in ettecL The undersigned as owner or
<br />representative of the herein-described premises here�y agrees as follows:
<br />(t ) That the cost af any extension ol the water service, renewal, repla�nment ar repair ro reach and serve the properry described shall be 6ome
<br />� by myself or assigns as owrer (s) o! Ihe premises.
<br />(?) Thal all pipes, tvater measuring devices and othor connecting equipmen[ upsiream (mm Ihe moter shall, alter Iheir instaliation, ho and bec�me
<br />Ine properry ot the MUKILTEO WATER DISTRICT, subject ro all its regulations pertaining to water serviee.
<br />(3) That aller installation, if ineler or meter box and appurtences aro buriea or damaged, ihe owner, will be held responsihlo and charged (or,ame.
<br />(4) That the MUY.ILTEO VJATER DISTRICT, its officers andagents, shall have lhe right af ingress and e�ress ro c�o upon the premises �nd pmperty
<br />described herein tor the purpose nf inspec�inn, connecting ar disconnecting the savice or for such other purposes as the service may require.
<br />It is also understood during the time Ihat any o( the water mains may be out ot scrvico by reason o( any emergency or imorovements authorized
<br />6y Ihe DISTRICT, in any sireet or other location in which iney may have been laid, the DISTRICT v:ill not be requirea to furnish water during
<br />the pmgress of such improvements to any consumer whose supply may ihus be cut olf, or be 1ia61a tor any dama�es for its failure to do so.
<br />(5) That ihe DISTRICT shall havo the right ro chanc�e the rams at any time by Resolution, to temporarily discontinue the service to consumers, and
<br />toinsiallihemeter(s) lorec�isterthewaterconsumed. TheDISTRICTshallnatbeheldlia6lefordamxgebywatcrorothercauseresWtingfrom
<br />detective plumbing or appliances installed hy the owner ar occupant on !he premises supplied with water, and the fact Ihat a9enL ot the D ISTRICT
<br />may have inspeded the plum6in� and appliances shatl not be plead as a basis for recovr.ry in case ot damage as aforesaid. II thc supply o(
<br />watershallfailorbeinterruptedbyreasonofaccident Iowpressurearolhercausewhatsoever,theDISTRICTshallnotbeheldlia6le(ordamages
<br />nor shall such failure or interruption forany reasonable time 6e held lo consliiutc a breach al contract an the part ot the DISTRICT or in any w.ry
<br />relieve thr, consumer, whether tenant or .:wner, iro� performing the o6ligation of such tenanPs or owner's contracL Water shall be used by
<br />applicant only on Ihe premises descri6ed herein. A new applicalion shall be filed should water be desired (or other premises alihough located
<br />��� r ) on I�nd described herein. •�'
<br />iur �i.,_i���.(t) Thm �he DISTRIC7 recommends Installalion of o pressure regulating valve. Applicanl ucknowledges information as to ihe
<br />I �\ recommendatlon and assumes fuli responslbllhy lor Instplling or'�lling to Instali a pressum regulaling value on lhe waler syslem'o
<br />u:i�� pro�ecl il Irom high pressurc.
<br />�'_✓�7) The DISTRICT utilizes check valv�s at Ihe meler in prevenl water relurning �o Ihe Dislricis malns. The DISTRICT recommends
<br />� ins�allationo�athermalezpansiontani•topreventexcessivepressurehuild-upcausedbythewatenc�ater.ApplicautsncknowleCges
<br />�^ � � inlonnation as to thc recommendotion nnd assumes fuil responslbiity for Inslallinc� or falling lo Ins�all a Ihermal ezpansion tank.
<br />` � � S�RVICE ADDRESS: /Dy� (/` q � � /�L�l/ LOT IJO. _ ,s� BLO ( _
<br />�
<br />,�./ �/� PLAT NAME: � � ! .-
<br />CITY/STATE2IP: i��i(-/ %v, D L� LcGAL DESCRIPTION: i
<br />A /
<br />.OWNER'S NAA�7E:/I�%%��S_�l�// ��,_
<br />OWNER'S ADDqESS: � �'' � � '
<br />CITY�STATEl7_IP: �,�i�/i� ��i� G���,�
<br />Tnc premises arc to be used as a
<br />� ;[� � 2—�s.�iG/
<br />ri
<br />WFORMATION LETTeR-GAVE/SENT: ' =
<br />cHaaces: /J PAID
<br />(1) Servica installation 8 canr�ection ch�rge S ��/`� �/'~!/
<br />(2) Geneml Facilities connection charge $ ��'�"� ./?�,/ SEP Q 9 1993
<br />�3� om�� ..'. ._ 5 1���KILTEO WA7ER DISiRICi
<br />Total, amount mceivod with applicalion . 5 ��l c��;,L
<br />1715 UNDERSTOOD that this Appiication, although signed, shall not he binding upon Ihe MUKILTEO WATER DISTRICT until approved by the D!�7��ICT.
<br />I, ihe undersigned, owner (or representative) of �he property described above, do hereby make application 'or ins;a!laiion ol a �� _-inch
<br />diameler water sup ly service •:onnection, indudiqp a��uner�ances, and all ne e�ar� iabor at my expenses.
<br />Cated this _� day ot _,a,���/�Z� f�"��
<br />�PPLICANT'S SIGIJATURE: X�,�� � /�'� /�II�L� � �.�
<br />Applican�'s �amc (plc�se prin�J:
<br />._ ApplicanYs Address and Phone
<br />APPROVE�; � ', ���/ %�� %' ' � ✓
<br />MUKILT � � TER DISTRICT
<br />i
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